2017 annual report - Cobb & Douglas Public Health

2017 ANNUAL REPORT

Cobb & Douglas Public Health - Mission Cobb & Douglas Public Health, with our partners, promotes and protects the health and safety of the residents of Cobb and Douglas counties. We work to achieve healthy people in healthy communities by: • • • •

Preventing epidemics and spread of disease Protecting against environmental hazards Preventing injuries Promoting and encouraging healthy behaviors

• Responding to disasters and assisting in community recovery • Assuring the quality and accessibility of health care

By excelling at our core responsibilities, we will achieve healthier lives and a healthier community.

Cobb & Douglas Public Health - Vision By 2020, Cobb & Douglas Public Health will be an acknowledged leader among health departments in the United States. In order to continuously improve our effectiveness and the health of our communities, we will work internally and with community partners to: • Demonstrate significant improvement on key health and safety indicators • Achieve operational excellence by exceeding local public health system performance expectations • Champion workforce enhancement To achieve these ambitious goals, we will engage, respect and value our staff and partners, thereby creating healthier lives and a healthier community.

Cobb Board of Health Dr. Carol Holtz | Chairwoman

Mr. Mike Boyce

Dr. Grant Rivera

Distinguished Lecturer and Current Professor of Nursing at Kennesaw State University

Chairman, Cobb County Board of Commissioners

Superintendent, Marietta City Schools

Mr. W. Wyman Pilcher, III | Vice-Chair

Royden Daniels, M.D.

Ms. Judi Snelson

Red Radiology

Retired Educator

Mr. Chris Ragsdale

Mr. Steve “Thunder” Tumlin

Superintendent, Cobb County School District

Mayor, City of Marietta

Dr. Romona Jackson Jones Chairwoman, Douglas County

Ms. Queen Esther Martin

Retired, Former President, First National Bank of Cobb County

Douglas Board of Health Dr. Charles Craton | Chairman Physician, WellStar Douglas Hospital

Mr. Trent North | Vice-Chair Superintendent, Douglas County School System

Board of Commissioners

QueenSongbirdEnterprises

Ms. Rochelle Robinson

Ms. Faymarie Landers

Mayor, City of Douglasville

Former Federal Mediator, National Mediation Board, Washington, D.C.

Mr. Ron Wilson CEO, Jourdan Technologies

Cobb & Douglas Public Health Leadership Team Cynthia Appleby – Director, Human Resources Pam Blackwell – Director, Center for Emergency Preparedness & Response Lisa Crossman – Deputy Director Valerie Crow – Director, Office of Communications Chris Hutcheson – Director, Center for Environmental Health

Jonathan Kemp – Director, Information Technology John D. Kennedy, M.D. – District Health Director Virgil Moon – Director, Center for Administration Gurleen Roberts – Director, Office of Quality Management Laurie Ross – Director, Family Health Management Catharine Smythe – Director, Center for Clinical Services

A Message From the Director Since 1920, Cobb & Douglas Public Health has served the communities of Cobb and Douglas counties, providing quality healthcare services, health education, and health surveillance/monitoring to our residents through the tireless efforts of the health professionals who drive and support our more than 30 programs. Each year, we continue to grow as a leader in the public healthcare sector, focusing on results-driven methods that helped us become the first health department in the state of Georgia to receive national accreditation from the Public Health Accreditation Board in 2015. This year, we were the first health department in Georgia and one of only three (3) in the country to earn the Government Finance Officers Association of North America (GFOA) Award of Excellence for financial reporting. Our programs also earned several National Association of County and City Health Officials (NACCHO) Model Practice Awards which helped us demonstrate very high standards of performance. We continue to make service a priority agency-wide. A new Customer Satisfaction Survey was launched in FY2017, helping our staff to adapt better to customer needs. The feedback helped drive many of our quality improvement projects implement new ideas such as the partnership with a contract pharmacy to provide home medication delivery, and clinical support for HIV clients. During 2017, we completed significant renovations to our Marietta Public Health campus and our Douglas Public Health Center. The additional space has allowed up to better serve our residents and has received rave reviews from both staff and clients. We also began plans for 2018 construction of our new health centers in the Acworth/Kennesaw and Smyrna areas. Out in the community, we supported one of the biggest changes to Cobb County in some time – The Atlanta Braves’ move to SunTrust Park. Our Environmental Health staff worked enthusiastically to complete the permitting process for almost 100 food service establishments at the new stadium in advance of its first exhibition game on March 31, 2017. In addition, our staff and community health coalitions partnered with the Georgia Department of Public Health, The Atlanta Braves and The Battery Atlanta to develop and implement national model tobacco-free policies. Our Emergency Preparedness & Response staff worked with the Braves and local public safety leaders to assure policies and protocols were in place to deal with future man-made or natural crises. With the help of our partners, business, and community leaders, we hosted the 16th Annual Power in Truth Conference for more than 450 teens in Douglas County. The conference featured workshops to educate the students on life skills and techniques related to the prevention of chronic diseases, drug and alcohol use. These practices earned our event the National Association of County and City Health Officials (NACCHO) Model Practice Award for FY2017. It is my pleasure, as the director of Cobb & Douglas Public Health, to present you with our FY2017 Annual Report. I encourage you to visit our website at cobbanddouglaspublichealth.org to learn more about our organization and the services we provide. I would also like to thank the Georgia Department of Public Health, our Boards of Health, Cobb and Douglas County Government staff, our community partners, and supportive residents that remain committed to our mission of “Healthier Lives and a Healthier Community.”

TABLE OF CONTENTS CDPH Mission/Vision. . . . . . . IFC A Message from Dr. Kennedy. . . . . . . . . . . . . . . . . 1 CDPH Center Overviews . . . . . . 2 Epidemiology & Health Assessment. . . . . . . . . . . 3 Cobb County Demographics. . . . . . . . . . . . . . . 4 Leading Causes of Death in Cobb County. . . . . . . . . . . . . . 6 Chronic Diseases in Cobb County. . . . . . . . . . . . . . . . 7 Infectious Diseases in Cobb County. . . . . . . . . . . . . . . . 8 Mental and Behavioral Health in Cobb County. . . . . . . . . . . . . . 9 Maternal, Child and Adolescent Health in Cobb County . . . . . . 10 Douglas County Demographics. . . . . . . . . . . . . . . 11 Leading Causes of Death in Douglas County . . . . . . . . . . 12 Chronic Diseases in Douglas County . . . . . . . . . . . . 14 Infectious Diseases in Douglas County . . . . . . . . . . . . 15 Mental and Behavioral Health in Douglas County . . . . . . . . . . 16 Maternal, Child and Adolescent Health in Douglas County. . . . 17 Key Moments. . . . . . . . . . . . . . . 18 Success Story . . . . . . . . . . . . . . 19 Financials. . . . . . . . . . . . . . . . . . 20 Quality Management/ Accreditation. . . . . . . . . . . . . . . 21 FY2017 - By the Numbers. . . . 22

John D. Kennedy, M.D. District Health Director Cobb & Douglas Public Health

Looking Forward . . . . . . . . . . . 24 CDPH Locations and Foundations . . . . . . . . . . . . . . . 25

Cobb & Douglas Public Health Center Overviews Center for Clinical Services This center offers a wide-range of exceptional, cost-effective health services for both adults and children. The doctors, nurses, technicians and educators on our teams are some of the most caring and respected in their fields, striving daily to lead others and raise the bar for compassion, confidentiality, professionalism and attentive customer care. In addition to our on-site clinical offerings, we also offer an extensive referral network to guide clients to any additional medical or social services needed.

Center for Community Health This center focuses on preventing the spread of diseases, supporting families non-clinical health needs and helping communities, businesses and residents adopt healthy lifestyles. Our staff provides community assessment, policy development and education related to tobacco and alcohol reduction, balanced nutrition, physical activity, injury prevention, and family health preventative care. We link residents to needed community services and help support an extensive network of partners, including Cobb 2020, Live Healthy Douglas and Safe Kids.

Center for Emergency Preparedness & Response (EP&R) This center continues to focus on the goal of community preparedness. EP&R supports emergency preparedness of community responders, area hospitals and local partners in preparing for, and responding to emergency events. In emergencies, the EP&R team collaborates with local, state and federal partners to handle any crisis and relay current and accurate information to the residents of Cobb and Douglas counties. The center accomplishes this feat through several programs offering a full-range of preparedness functions.

Center for Environmental Health (EH) This center makes sure that businesses and recreational services are safe for consumers by permitting and inspecting restaurants, public pools, tourist accommodations, and body art studios. Additionally, the EH staff works to assure that septic systems are installed correctly and that public health nuisance issues are promptly resolved.

Center for Administration This center includes several areas that oversee day-to-day administrative functions. The administrative tasks include managing business operations as well as creating an efficient organizational process. The Center for Administration is comprised of the following divisions: Accounting (Budgeting, Payroll, Purchasing and Accounts Payable), Billing and Collections, Human Resources, Facility Management, Information Technology, and Vital Records. The divisions work together to support the various programs offered by the agency to ensure public health services are delivered in a timely, responsive, and professional manner. While only Vital Records directly serves the public, each of the other groups support those serving the public.

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Center Highlights for FY2017 Epidemiology & Health Assessment The primary mission of the Cobb & Douglas Public Health (CDPH) Epidemiology & Health Assessment department is preventing epidemics and the spread of disease within our community. This includes local tracking, testing and education related to world-wide outbreaks (e.g., Zika) and being the primary investigator/prevention specialist for local outbreaks in schools, long-term care facilities, corporate settings, hotels and restaurants. Per OCGA 31-12-2, diseases deemed notifiable by the state must be reported to Public Health by physicians, laboratorians, and other health care providers. Timely disease reporting is essential for effective follow-up for patients, to help identify the outbreaks, and to reduce the further spread of the disease. CDPH epidemiologists are also responsible for conducting the Cobb and Douglas Community Health Assessments (CHA) and tracking key health status metrics to determine progress toward CDPH’s 2020 goals. In 2016-2017, CDPH partnered with Kennesaw State University, Cobb2020 Partnership for Health and the Live Healthy Douglas Coalitions to complete a thorough CHA document for both counties. This CHA set the stage for the 2017-2021 Community Health Improvement Plan (CHIP) for both counties, also completed in 2017. Available to all residents in our district, the CHIP sets priorities and action steps to guide CDPH and other agencies in creating healthier lives and a healthier community.

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Cobb County Demographics Cobb County: Socio-Demographics 750,000

741,334

730,000 710,000

707,442

717,190

730,981

Cobb County’s Population Continues to Increase, 2011-2015

697,553

690,000 670,000 650,000

2011

2012

2013

2014

2015

Source: Online Analytical Statistical Information System, Office of Health Indicators for Planning, Georgia Department of Public Health, 2016

Cobb County’s population increased by 6.3% in a five-year span, from 697,553 in 2011 to 741,334 in 2015.

1%

Population by Race, Cobb County, 2015

5%

2%

White Asian Native Hawaiian or Pacific Islander Black or African-American

28%

64%

Multiracial


While Cobb County’s population remained predominately White (64% in 2015), the county saw larger increases in minority populations between 2011 and 2015: • the African American population increased by 14.2%, from 180,339 to 205,979; • the Asian population increased by 20.2%, from 32,657 to 39,258; • the Multiracial population increased by 18.6%, from 15,096 to 17,908; • the Hispanic or Latino (any race) population increased by 8.4%, from 87,477 to 94,853. 4

Socio-Demographic Snapshot of Cobb County Language Cobb County contained 274,468 households between 2011-2015, and 3.6% of Cobb County households had limited English-speaking ability.1

Age The median age in Cobb County was 36.3 years in 2015, an increase from 35.6 years in 2011. Between 2011 and 2015, residents 35–64 years old comprised the largest age group, at 41%. However, the number of residents 65+ years old increased by 28.5% during this time period.2

Income The 2010–2014 median household income (in inflation-adjusted 2014 dollars) in Cobb County was $64,657. This is higher than both the US and Georgia median household incomes of $53,657 and $49,342, respectively. In the same 2010–2014 time frame, the per capita income in Cobb County was higher than the state average, at $33,418 and $25,427, respectively.3

Employment The unemployment rate in Cobb County was 5.9% in 2015, down from 11.1% unemployment in 2011. In 2015, 70.4% of Cobb County residents aged 16 and older were in the civilian labor force, with a civilian employed population of 383,927.1

Poverty 12.4% of Cobb County residents were below poverty level between 2011-2015, compared to 18.4% of Georgia residents below poverty level in the same time period. Poverty levels disproportionately affected some residents of Cobb County by race and ethnicity, age group, educational attainment, and employment status between 2011-2015: • • •

17.6% of African-Americans and 25.5% of Hispanics were below the poverty level, compared to 7.3% of the White, non-Hispanic population below the poverty level. 17.4% of children under the age of 18 were below the poverty level, compared to 11.3% of adults aged 18-64, and 7.2% of adults 65 years and over. 25.7% of residents with less than a high school diploma were below the poverty level, compared to 15.1% of high school graduates (or equivalent) and 4.2% of those with a Bachelor’s degree or higher below the poverty level.1

Health Insurance Of the civilian non-institutionalized residents of Cobb County, 13.3% had no health insurance coverage in 2015, a decrease from 18.7% in 2011.4

Education Cobb County high school (Cobb and Marietta districts combined) graduation rates increased 20.5% over the 2011–2015 timespan, from 64.8% to 78.1%. However, within Cobb County, Hispanic (56.9%) and African-American (65.4%) students had lower graduation rates than their Asian (89.8%) and White (85.6%) counterparts. Economically-disadvantaged students (all races) also had lower graduation rates, at 70.2%.5

Housing The median value of Cobb County’s owner-occupied housing units (2011–2015) was $197,400, which is higher than the median value of $148,100 in Georgia during the same time period. The median gross rent in Cobb County (2011-2015) was $1,006, also higher than the Georgia median gross rent of $879.1

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Leading Causes of Death in Cobb County The dashboard below represents the age-adjusted death rate for the 10 most common causes of death in Cobb County.

Ranked Causes and State/County Comparison, Age-Adjusted Death Rate, Cobb County, 2011-2015 GA

GA

#

1

Ischemic Heart & Vascular Disease (e.g., Heart Attack) 1,528

GA

#

2

All Other Mental & Behavioral Disorders* 1,328

GA

#

6

Alzheimers Disease 646

GA

3

4

#

#

Malignant Neoplasms of the Trachea, Bronchus and Lung (e.g., Lung Cancer) 1,114

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Accidental Poisoning and Exposure to Noxious Substances 439 The dashboard arrow indicates where the county ranks compared to the state of Georgia. All rankings are age adjusted.

The number in the circle indicates the cause of death ranking within the county between 2011-2015.

Cerebrovascular Disease (e.g., Stroke) 967

GA

GA

#

GA

GA

8

#

GA

5

All COPD Except Asthma 862

GA

#

Malignant Neoplasms of Colon, Rectum and Anus (e.g., Colon Cancer) 422

#

9

Septicemia (e.g., Blood Poisoning) 413

#

10

Pneumonia 411

The color-coded gauge represents percentiles from the lowest county death rate (green) to the highest county death rate (red).

Cause of Death 100

The number below the cause of death indicates the total number of deaths for this cause between 2011-2015.


Leading Causes of Premature Death in Cobb County, 2011-2015 Premature death is defined as death before age 75. The top causes of premature deaths in Cobb County below are ranked by Years of Potential Life Lost (YPLL), which is the number of years a person died before age 75. 1. 2. 3. 4. 5.

Accidental poisoning and exposure to noxious substances* Certain conditions originating in the perinatal period Intentional self-harm (Suicide) Ischemic heart and vascular disease (Heart attack) Motor vehicle crashes

6. Malignant neoplasms (Cancer) of the trachea, bronchus, and lung 7. Assault (Homicide) 8. Congenital malformations, deformations and chromosomal abnormalities 9. Cerebrovascular disease (Stroke) 10. Malignant neoplasm of the breast (Breast cancer)

*The #1 cause of premature death in Cobb County between 2011-2015 was due to accidental poisoning by and exposure to noxious substances, defined by the World Health Organization as accidental (specifically not suicidal or homicidal) overdoses; the wrong drug being given or taken in error; drugs taken inadvertently; drug-related accidents in medical and surgical procedures; and accidental or not-clearly-intentional poisoning.10 It was previously the #4 cause of premature death. The primary group affected between 2011-2015 was White males aged 20-34 years old, with 113 deaths in that five-year period.2 6

Chronic Diseases in Cobb County Cardiovascular Disease Cardiovascular disease is the #1 cause of death in both men and women across the United States and in Cobb County. It is responsible for 1 in every 4 deaths, and it kills about 610,000 people in the U.S. every year. Two components of cardiovascular disease were responsible for many deaths in Cobb County between 2011–2015: 1. Ischemic heart & vascular disease, better known as “heart attack” – the #1 cause of death 2. Cerebrovascular disease, better known as “stroke” – the #4 cause of death Death rates due to cardiovascular diseases in Cobb County between 2011–2015 differed greatly by sex and racial groups: • Males had a higher death rate from cardiovascular disease (165.0 per 100,000) than females (153.0). • White males had the highest death rate (206.3 per 100,000), followed by White females (199.3). African-American males and females died from cardiovascular disease at nearly half those rates, at 104.6 and 90.1 per 100,000, respectively.2

Cancer Three types of cancer (Cancer of the Trachea, Bronchus, & Lungs; Colon, Rectum & Anus; and Breast) were in the top 10 causes of death & premature death in Cobb County between 2011-2015. Both Cobb County’s and Georgia’s age-adjusted mortality rate due to all types of cancer declined slightly over that same time period, but Cobb County’s average rate (147.1 per 100,000) was lower than Georgia’s statewide rate (164.9). Death rates due to cancer in Cobb County differed greatly by sex, race, and age groups: • Males had a higher death rate from cancer (130.5 per 100,000) than females (119.2). • White males had the highest death rate (163.0 per 100,000), followed by White females (144.5). African-American males and females died from cancer at about half those rates, at 73.6 and 88.2 per 100,000, respectively.2

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Infectious Diseases in Cobb County

Infectious diseases are caused by pathogenic microorganisms such as bacteria, viruses, and parasites. These diseases spread from person to person through a variety of methods, and may lead to epidemics. A primary mission of CDPH is preventing epidemics and the spread of disease within our community. Per the legal authority of the Official Code of Georgia (OCGA section 31-12-2), diseases deemed notifiable by the state must be reported to Public Health by physicians, laboratorians, and other health care providers. For more information on reporting diseases, visit https://dph.georgia.gov/disease-reporting. One of the notifiable diseases, syphilis, remains a major and increasing health problem both locally and nationally. It is a bacterial infection that may cause genital ulcers and other, potentially fatal effects. If syphilis is left untreated, it may contribute to transmitting and acquiring HIV infection. In 2015: • Georgia reported the second-highest rate of primary and secondary (P&S) syphilis in the US—14.0 per 100,000—which is nearly double that year’s national rate; • Cobb County reported the 60th-highest number of primary and Secondary syphilis cases in US counties and independent cities (11.2 per 100,000); • Males made up the vast majority of primary and secondary syphilis cases, both locally and nationally; • African-Americans (both genders, all ages) had the highest rate of P&S syphilis in Cobb County.2

NOTIFIABLE DISEASE / CONDITION REPORTING All Georgia physicians, laboratories, and other health care providers are required by law to report patients with the following conditions. Both lab-confirmed and clinical diagnoses are reportable within the time interval specified below.

Reporting enables appropriate public health follow-up for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Georgia. For the latest information from the DPH, Department of Public Health, visit their web site at: dph.georgia.gov/

REPORT IMMEDIATELY To Report Immediately

Call: District Health Office or 1-866-PUB-HLTH (1-866-782-4584)

any cluster of illnesses animal bites anthrax all acute arboviral infections: -Eastern Equine Encephalitis (EEE) -LaCrosse Encephalitis (LAC) -St. Louis Encephalitis (SLE) -West Nile Virus (WNV) botulism brucellosis cholera diphtheria E. coli O157 Haemophilus influenzae (invasive)* hantavirus pulmonary syndrome hemolytic uremic syndrome (HUS) hepatitis A (acute) measles (rubeola) meningitis (specify agent) meningococcal disease novel influenza A virus infections pertussis plague poliomyelitis Q fever rabies (human & animal) severe acute respiratory syndrome (SARS) shiga toxin positive tests S. aureus with vancomycin MIC > 4µg/ml smallpox syphilis (congenital & adult) tuberculosis latent TB infection in children 4µg/ml smallpox syphilis (congenital & adult) tuberculosis latent TB infection in children